The 2011 WPATH Standards of Care and Penile Reconstruction in Female-to-Male Transsexual Individuals
Table 3
Techniques for female-to-male sex reassignment surgery [18, 22].
Surgical technique
Limitations
Benefits
Metoidioplasty (metaidoioplasty)
Short phallus Very rarely capable of sexual penetration Not always enable for voiding whilst standing Overall complication rate less than 20%
Easy technique Lower risk of complication Quick recovery time No donor-site morbidity
Phalloplasty
Radial forearm flap
Urinary tract problems Multiple stages Stiffener required, or permanent erection if bone is used Donor-site morbidity Microsurgical skills required
Possible ability for sexual intercourse. Possibly, best cosmetic result? (overall complication rate up to 40%)
Anterolateral thigh flap
Possibly similar limitations to radial forearm flap No long-term followup available
Easier to hide the donor site disfigurement Usually harvested as a pedicle flap
Fibula flap
Possibly similar limitations to radial forearm flap Permanent erection No recent long-term follow-up available Microsurgical skills required
Easier to hide the donor site disfigurement
Latissimus dorsi flap
Urinary tract not reconstructed Erection function (based on muscle contraction) questionable Donor-site morbidity Sexual and tactile sensitivity not reported No long-term follow-up available Microsurgical skills required
No need of inflatable erection device
Suprapubic flap/groin flap
Cosmetic appearance unsatisfactory Donor-site morbidity? Urinary tract problem Fully or partially sensate? Stiffener or erection possible? Multiple stages If urethra is reconstructed, usually it is reconstructed in a different stage, and rarely reach the tip of the penis, but it often opens ventrally Groin flap requires a minimum of two stages
